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Organization
PHYSICAL THERAPY ASSOCIATES, LLC
Active
Organization
PHYSICAL THERAPY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY C SCHADE PHYSICAL THERAPIST (OWNER)
(815) 844-4690
Entity
Organization
Contact information
Practice address
924 W CUSTER AVE, PONTIAC, IL 61764-1067
(815) 844-4690
(815) 844-4810
Mailing address
924 W CUSTER AVE, PONTIAC, IL 61764-1067
(815) 844-4690
(815) 844-4810
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5732116
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/24/2006
Last updated
10/31/2007
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